Background and Objectives: This prospective cohort study aimed to evaluate the onset and severity of pain and other complications following lower impacted third molar extraction and to identify potential risk predictors. Materials and Methods: Twenty-five patients were treated with at least one lower impacted third molar extraction. The primary outcome was the onset of post-operative pain, evaluated at 6 h, 12 h, 24 h, 48 h, 72 h, and 7 days. The secondary outcomes (trismus, edema, alveolitis, dehiscence, neuralgic injury, and suppuration) were recorded at 3, 7 and 21 days after oral surgery. A correlation analysis was performed to identify potential associations between patient- and tooth-related factors and VAS (Visual Analogue Scale) scale. When a statistically significant correlation was identified, a regression analysis was performed. Results: Most of the patients were female (84%) with a mean age of 25 ± 3 years; the reason for oral surgery was dysodontiasis in 60% of cases, while the most frequent Pell and Gregory class was BII (36%). The VAS scale showed the onset of mild pain at 6 h (44%), 12 h (48%), 24 h (68%) and 48 (68%) after surgery. Trismus, edema, and alveolitis were observed at 3-day (20%, 64% and 12%, respectively) and at 7-day (16%, 12% and 4%, respectively) follow-up. Neuralgic injury was reported in one case (4%). The linear regression analysis showed a statistically significant association (p < 0.05) between the duration of oral surgery and VAS scores at 6 and 12 h. Finally, the binary logistic regression identified systemic disease, Pell and Gregory classification, duration of oral surgery, VAS at 6 and 12 h, trismus, and edema at 3 and 7 days as predictive factors of post-operative complications. Conclusions: Within their limits, the results of this study suggest that the onset of post-operative complications increases in proportion to the duration of the surgical procedure.

Objectives: The objective of this narrative review was to evaluate the clinical challenges encountered in the application of the 2018 AAP/EFP Classification of Periodontitis. Methods: Electronic and manual searches were conducted to identify studies reporting diagnostic accuracy and inter- and intra-examiner agreement when using the 2018 Classification, both with and without the aid of implementation tools. Results: Eleven studies were included, encompassing a total of 459 clinical cases. Overall, 852 examiners participated, with 31 gold-standard examiners providing the reference diagnoses. General dentists often exhibited lower diagnostic accuracy and consistency compared to students and periodontal experts. Diagnostic challenges were observed in staging, particularly distinguishing between Stage III/IV and gingivitis/Stage I. Grading reliability was reduced in the absence of longitudinal data and high-level modifying factors. This review also explored difficulties in reporting ‘hopeless teeth’ and assigning the extent of periodontitis. Education, training, and implementation tools substantially improved diagnostic accuracy and consistency, increasing the agreement with reference diagnosis and strengthening inter- and intra-examiner agreement. Conclusions: The application of the 2018 Classification showed notable variability in diagnostic accuracy and inter- and intra-examiner agreement. Improving clinician experience and training and incorporating diagnostic aids and emerging AI technologies has the potential to enhance diagnostic accuracy and consistency, which are essential for precisely estimating periodontitis prevalence, interpreting research findings, and determining prognosis and treatment needs.

Background: Periodontitis is a chronic inflammatory disease characterized by the destruction of periodontal tissues due to biofilm deposits and altered host immune response. Non-surgical periodontal therapy (NSPT) still represents the gold standard for treatment; however, its effectiveness in deep periodontal pockets is limited. Probiotics seem to modulate both oral microbiota and inflammatory response and have been proposed as an adjunctive therapy to NSPT. Methods: An electronic search was conducted on PubMed, Scopus, Medline, and Google Scholar to identify English randomized controlled trials (RCTs) evaluating probiotics as adjunctive treatments to NSPT. Studies were selected based on inclusion and exclusion criteria, and clinical outcomes such as probing depth (PD) and clinical attachment level (CAL) were extracted and analyzed. Results: Seven RCTs met the inclusion criteria. These studies showed significant improvements in PD and CAL when probiotics were used, specifically with Lactobacillus and Bifidobacterium species. However, outcomes ranged depending on the strain, dosage, and delivery method. Conclusions: Probiotics may be used as an adjunct treatment to NSPT; however, further studies are needed to define valid clinical guidelines.

Background: Third lower molar (TLM) extraction is one of the most common oral surgical procedures, often accompanied by postoperative pain and inflammation. In order to treat postoperative pain, different methods are used, mainly based on painkillers. PBMT may represent an adjunct to pain management. Objective: This narrative review aims to evaluate the efficacy of PBMT in reducing postoperative pain following TLM extraction. Methods: A comprehensive search was conducted to identify studies examining the use of PBMT for postoperative pain relief after TLM extraction. Four randomized controlled trials (RCTs) met the inclusion criteria and were analyzed qualitatively. Results: Two studies showed statistically significant reductions in pain with PBMT. Kahraman et al. reported lower pain scores in the intraoral PBMT (p = 0.001), with up to a 3.2-point reduction on the Visual Analog Scale (VAS). De Paula et al. found improved pain control using a dual-wavelength (808 + 660 nm) versus a single wavelength protocol (p = 0.031). The remaining studies showed non-significant results toward pain reduction. Conclusions: PBMT shows encouraging results in managing postoperative pain after TLM extraction, specifically with intraoral and multi-wavelength protocols. However, further studies are necessary to confirm its clinical utility.

Non-surgical periodontal therapy (NSPT) represents the gold standard in the treatment of periodontitis, but deep periodontal pockets and complex anatomies may reduce its efficacy. Therefore, in order to enhance NSPT outcomes and reduce the need for surgical intervention, several adjunctive therapies have been proposed. Propolis, a natural substance with antimicrobial, anti-inflammatory, and healing properties, has shown promising results in controlling supragingival biofilm. This narrative review aims to assess the clinical efficacy of propolis as an adjunct to NSPT. A comprehensive search on scientific databases was conducted for randomised clinical trials (RCTs) comparing NSPT with and without propolis, or with other adjuncts or placebos. Probing depth (PD) was the primary outcome. Seven RCTs met the inclusion criteria, using different propolis formulations and application protocols. Statistically significant improvements in clinical outcomes were recorded in all analysed studies compared with NSPT alone or placebo, while benefits were less substantial compared with laser therapy and conflicting when compared with chlorhexidine. Thus propolis may be considered a promising adjunctive agent to NSPT, with the potential to improve clinical outcomes of NSPT. Nonetheless, further long-term clinical trials with larger sample size are needed to validate its clinical efficacy and to determine its adverse effects.

Aim: To assess the clinical response to Non‐Surgical Periodontal Therapy (NSPT) between suprabony and intrabony defects.Materials and Methods: Totally 200 NSPT patients' records from the King's College London—Oral, Dental and Craniofacial Biobank were included. Periapical radiographs of sites with Periodontal Probing Depth (PPD) > 4 mm were assessed. Changes in periodontal measurements between baseline and three‐month re‐evaluation were examined and compared across suprabony and intrabony sites. Multilevel analysis was carried out to assess the relative contribution of site‐, tooth‐, patient‐ and treatment‐related factors on the clinical outcomes.Results: Although intrabony defects showed higher PPD reduction after NSPT compared with suprabony defects, this was a function of initial deeper PPD. In fact, suprabony defects outperformed intrabony defects for ‘pocket closure’ at every initial PPD threshold and overall were 2.60 times more likely to achieve ‘pocket closure’. Defect morphology was one of several factors affecting treatment outcomes. The relative contribution to ‘pocket closure’ was 64.9% for site‐, 26.1% for patient‐, 9.0% for tooth‐ and 1% for treatment‐related factors.Conclusion: Bone defect morphology influences clinical outcome of NSPT, with suprabony defects being twice as likely to achieve pocket closure and resulting in 0.6 mm more PPD reduction compared with intrabony defects.